Provider Demographics
NPI:1407095540
Name:NORTHEAST ORTHODONTIC SPECIALISTS
Entity Type:Organization
Organization Name:NORTHEAST ORTHODONTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALMEIDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-658-1116
Mailing Address - Street 1:8 CREPEAU BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-2107
Mailing Address - Country:US
Mailing Address - Phone:401-658-1116
Mailing Address - Fax:401-658-1117
Practice Address - Street 1:8 CREPEAU BLVD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-2107
Practice Address - Country:US
Practice Address - Phone:401-658-1116
Practice Address - Fax:401-658-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1598761884Medicaid
RI1730368390Medicaid